How working in underserved communities grows empathy and efficiency of Michigan's pediatricians

For a long time, Dr. Allison Tripi knew she wanted to help children in need as a doctor. She figured she could earn her medical degree, and then volunteer her time in underserved communities. She never thought, however, that she could make an impact during one of the most critical experiences of her medical training—her residency. 

As a third-year medical student at Michigan State University College of Osteopathic Medicine, Tripi learned about a unique opportunity to gain practical clinical experience in the inner city through Authority Health, a Detroit-based nonprofit that extends state, county, and municipal health departments to support the public health infrastructure, and provide connections between medical communities that don't usually exist.
Neither a hospital nor an educational institution, Authority Health operates pediatric, family, psychiatric, and internal medicine residency programs that put medical residents directly into the community for valuable training and experience. Tripi participated in the Community Medicine Rotation (CMR), a month-long urban immersion that was part of her Pediatric Medicine Residency Program.
"I thought I would have to do my job, and then volunteer to work with the underserved, but the CMR opened that door so I could do both," says Tripi, who has since become a pediatrician.

Tripi spends several days each month as attending physician in clinics at Focus:HOPE and Black Family Development, Inc. (BFDI). Once a resident herself, she now supports and oversees the medical residents on the CMR.
The CMR is one way Michigan organizations are using innovative approaches to improve child wellbeing. From providing individualized care and education right in the community where children live, to pioneering technology to alert busy emergency room physicians of suspected child abuse, physician caregivers are benefiting from unique approaches and promising tools to better care for children.

Immersed in the community

Innovation in healthcare can be complex, problem-solving technology or as simple as a change of perspective. By recognizing that inner city children, who often live in poverty and lack heat, food, and transportation, won't necessarily receive health care according to a standard care model, Authority Health, through funding from the Children's Hospital of Michigan Foundation (CHMF), opened mini-clinics inside Focus:HOPE and BFDI. Here, CMR residents get to know the environments that inner city children call home.

Staff at Black Family Development (left to right): COO Kenyatta Stephens, Dr. Tripi, and CEO Alice G. Thompson
By serving Head Start kids and educating Head Start teachers at Focus:HOPE, and supporting older children and teens at BFDI, CMR residents provide nonjudgmental services to a population that often carries a level of mistrust for doctors. Program residents don't replace primary care, but work to connect children to doctors, and hope to imprint positive first impressions on the kids.

"When children are little, they rely on their parents for their health care, and they form opinions and biases," says Kelly Panoff, program coordinator with Authority Health. "If they are given quality health care at a high level, they will be better off physically and mentally."

The families cared for at Focus:HOPE and BFDI are in extreme need, and benefit from basic care as well as plenty of health education.
"We are not as bound by time [as traditional physicians]," says Tripi. "So counseling is a huge part of what we do, and we provide health education sessions, along with normal physical exams."

CHMF funding provided a lead testing machine that Tripi is eager to put into practice. According to studies, lead levels are on the rise among Detroit children.
The month-long CMR also embeds residents in a dozen partner organizations throughout southeast Michigan where they treat patients at a free clinic in Wyandotte, serve children meals from the Salvation Army truck, and share health information and answer questions with women at Heartline Samaritas House Detroit.
"The core patient population is vulnerable," says Panoff. "This is a good way to take residents from all over the country who need what they don't get in their training: humanity 101."

Examination room at Black Family Development

The goal is to create more empathetic doctors, and some residents, like Tripi, are forever impacted by the experience.

"We know our patients come from difficult environments, or are impacted by the effects of incarceration, but it's eye opening to see it firsthand," she says. "This rotation helps residents check back in, and they’re more well-rounded as a result. They learn to approach all patients without judgement, and this has the best outcome for the child, and the family, as well as for the physician."

Helpful tool for busy ER docs

Correct diagnosis and treatment for the best possible outcome is always the goal of an emergency room physician. But in a fast-paced, high-pressure environment, it’s not always easy to spot abuse in the youngest of patients. That's why Dr. Usha Sethuraman, emergency room attending physician at Children's Hospital of Michigan (CHM) is working to implement an electronic alert system to help physicians use the correct tools to diagnose physical abuse in children under the age of 2.

While the American Academy of Pediatrics (AAP) has guidelines for action when a doctor suspects abuse, signs in pre-toddlers are subtle and often missed. 

"In pediatrics, abuse is a great masquerader," says Sethuraman. "Fussiness or even fever could be secondary to blood in the brain, or a fracture somewhere that is painful to the child. But it could also indicate an ear infection or sepsis, which are more common in this age group."

Nationally, nearly 80 percent of children who die from abuse are younger than 4 years old, and in Wayne County, about one in every 10 kids lived in a family that was investigated for child abuse in 2013. In Detroit, the number of confirmed child abuse or neglect cases in children 5 years and younger in 2016 was 2,636, up from 1,621 in 2012. 

Books for patients to read or take home

The proposed electronic alert system would work in conjunction with CHM's existing computerized records, and ask physicians if they consider abuse when certain parameters are met, and then, if appropriate, guide the doctor through the AAP guidelines.

"The tool is not necessarily making the diagnosis for the physician, but offering a prompt about considering abuse," says Sethuraman. "We see more than 90,000 kids a year, and most ERs are high-stress environments where symptoms are difficult to differentiate."

Provided by a grant from CHMF, the innovation was developed by Dr. Srinivasan Suresh and Dr. Rachel Berger at Children's Hospital of Pittsburgh, and will be modified to work with CHM's ER procedural routines before it is implemented, ideally by this fall. If successful, the system could expand to other departments and locations. 

This article is part of "Children of Michigan," a series on the importance of health and wellbeing for Michigan's children. It is made possible with funding from the Children's Hospital of Michigan Foundation.

All photos by Nick Hagen.
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Claire Charlton is a Metro Detroit freelance writer. Connect with her on FacebookInstagram, or Twitter.